Access to healthcare for migrants in Tunisia in 2023-2024: Current situation and ethical challenges.

INTRODUCTION: Transformed progressively into a transit country towards Europe but also as a host, Tunisia has seen a diversification of migratory movements since the 2011 revolution, as well as the profiles of migrants who face multiple difficulties that can have an impact on their health. AIM: This update aimed to expose the situation of migrants in Tunisia regarding access to healthcare, and to raise the ethical issues that result from it. RESULTS: Providing care to vulnerable individuals, especially migrants, compels us to reevaluate our practices and question ourselves. Ethical questioning is constant to determine how to do well and not harm. The reflection on this more humane "social medicine" comprehending the patient in its entirety, is only in its beginnings. The critical health status of the poorest populations and their extreme vulnerability do not only call for adapted and specific care measures but also a more comprehensive questioning of social ties and the place that our society grants to the weakest and excluded. CONCLUSION: Migration must be considered as a central issue of the ethics of the health of a population in order to provide quality care without prejudice.

A comparative study of the injury pattern between suicidal and accidental falls from height in Northern Tunisia.

BACKGROUND: Falls from height are a common cause of marbidity and mortality. The aim of this study is to examine the characteristics of the victims, the circumstances of the fall and distribution of the injuries of accidental and suicidal falls from height. MATERIALS AND METHODS: It was a retrospective cross-sectional study, based on autopsies performed over 16 years (January 2005 to December 2020). The recorded variables included demographic data of the victim, height of fall, death scene findings, length of hospital stay, autopsy findings, and toxicological results. RESULTS: Of the 753 victims of fall from height, 607 were fallers and 146 were jumpers. We found that male victims were predominant in the accidental group (86.8% vs. 69.2%). The mean age at death was 43.6 ± 17.9 years. Suicidal falls occurred in a private house in the majority of cases (70.5%), while accidental falls occurred most frequently at workplace (43.8%). Suicidal falls were higher than accidental falls (10.4 ± 7.3 m vs. 7.1 ± 5.7 m). Injuries in the thorax, abdomen, pelvis, upper and lower extremities were more frequentl in the suicidal falls group. Pelvic fractures were 2.1 times more likely to occur in the suicidal falls. Head injuries were more frequent in the accidental falls group. The survival delay was shorter in the suicidal falls group. CONCLUSIONS: our study highlights the differences in the profile of the victims and in the pattern of injuries caused by falls from height, depending on the victim's intention to fall.